The psychological impact of incontinence cannot be ignored
If incontinence is not managed well, the person with incontinence may experience feelings of rejection, social isolation, dependency, loss of control and may also develop problems with their body image. Equally, if not managed well, carers can feel overwhelmed with the stress arising from life and relationship changes, the financial burden of continence care, and the increasing time and cost spent on cleaning clothes and bedding.
Research tells us that many people with incontinence do not seek help. Depending on the individual’s personal beliefs and feelings about incontinence, the person you are caring for may:
- not be bothered by it
- try to hide it
- deny it
- not want to talk about it.
You may find these behaviours difficult to understand and accept, making it harder for you to help the person achieve the best outcomes for you both. As a carer, work out how much warning time there is (if any) and if the person you are caring for is aware of the problem. This will help you know when to attend to the person’s toileting needs before problems arise.
COMMON PSYCHOLOGICAL RESPONSES
As a carer, it's especially important to recognise your own changing emotions and feelings. Although the following is mainly written about the person you are caring for, some of it may also apply to you.
Sometimes when a person is challenged by a change in their life circumstance, a part of them may want to deny that there is a problem, even when there is overwhelming evidence that a problem exists. It may be embarrassment or it may be fear that’s behind the denial. Equally, denial might simply reflect that the person doesn’t fully or accurately understand what the problem is. Some may recall an aged parent having the same problem and believe incorrectly that nothing can be done to manage it effectively. Others believe that it is simply a result of ageing, having children or prostate surgery and therefore see no point in seeking help.
Even when people do seek help, they may not admit how serious the problem is. It is only as they become comfortable with their continence nurse advisor or doctor that they may be willing to reveal the full extent of the problem and be open to hearing about current continence management options.
Because passing urine (wee) or faeces (poo) is regarded as a very private and personal activity in most societies, many people are prone to feeling embarrassed about any accidental leaks and smell associated with incontinence. As a result, it is understandable that many people with incontinence and their carers might become very anxious when thinking about or planning social activities.
It is common for people experiencing anxiety to try to avoid the situation they most fear. They may try to reduce their anxiety by avoiding social activities such as shopping, going out or having friends over. It is also common for people experiencing incontinence to try to manage their problem by reducing the amount or type of food they eat or fluid they drink.
Frustration is a normal human reaction when a person feels they are unable to achieve something that they want, value, believe they have a right to, or believe that they should be able to do. A person who is incontinent may show their frustration when they are unable to master their incontinence or some aspect of their care or treatment.
A key to helping someone who is angry is to listen while you explore the needs that are unmet. Lack of sleep due to frequent toileting at night or from some other reason such as stress, pain or depression is likely to exhaust the person and you as their carer. Irritability, impatience and reduced tolerance can result and place severe strain on the health and relationships of both parties.
Carers and those with continence problems who are experiencing anger and frustration should seek advice from their doctor or continence nurse advisor on how to access support in managing these emotions.
Grief is a very normal response to any change in a person’s life. It represents their response to actual or perceived loss they experience as a result of that change. For that reason, grief is usually a transient state that lessens and passes with time as we adjust to a loss. Grief may feel like depression but tends to be different in the time it lasts, its intensity of feelings and the way that it affects a person’s beliefs.
However, grief is always an individual experience.
When a person comes to believe that things are hopeless and that they are helpless to do anything about it, they are very prone to becoming depressed.
If you think that you or the person you care for could be depressed, it is important to raise your concern with the doctor, as depression and incontinence are common conditions. For more information on symptoms of depression visit Beyondblue.
What can you do to help?
- Ask the doctor and/or health professional for help and keep regular appointments for review.
- Ask a Nurse Continence Specialist for support and guidance.
- Discuss the merits and consequences of medication.
- Engage them in 30 minutes of physical exercise daily.
- Encourage them to eat healthy and fresh food and drink at least 1.5-2 litres of fluid daily.
- Encourage them to achieve and maintain a healthy body weight. Being overweight is associated with many physical and psychological health problems.
- Discourage smoking and minimise alcohol and caffeine intake (alcohol can interfere with medications and make feelings worse).
- Practise healthy sleep habits.
Contact Carers Australia for counselling and support.
For further information on caring for someone with incontinence contact the National Continence Helpline on 1800 33 00 66.
The National Continence Helpline is staffed by Nurse Continence Specialists who offer free and confidential information, advice and support. They also provide a wide range of continence-related resources and referrals to local services.